Watermelon 5K/10/Mile Road Race
June 14, 2008
Cordele, GA

OFFICIAL ENTRY FORM – PLEASE PRINT

Please Print All Requested Information:

___________________________________________________________________
Name

___________________________________________________________________
Address

___________________________________________________________________
City ____________________State ________________Zip Code

T-shirt size: (Circle one) Adult:_____ S___M____ L____ XL____XXL
Sex: Male ____Female ____Age: _________

WAIVER:Waiver of Liability: In consideration of my acceptance of this entry, I hereby for myself, my
heirs and assigns, waiver any and all claims I may have against Impact Sports and Fitness volunteers,
staff, all sponsors, and the representatives for any and all injuries by me in the said event. I attest that
I am physically fit and trained for the event.

Signed: _____________________________________ Date: __________________________

Checks payable and mail to to:
Impact Sports and Fitness
1107 Greer Street
Cordele, GA 31015
Phone: (229) 271-1900
Fax: (229) 271-8179